Provider Demographics
NPI:1003100728
Name:ROBERTS, TIFFANY JUTERBOCK (PSYD, LMFT 53905)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:JUTERBOCK
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PSYD, LMFT 53905
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:DIANE
Other - Last Name:JUTERBOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:5400 KEARNY MESA RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1303
Mailing Address - Country:US
Mailing Address - Phone:619-717-2363
Mailing Address - Fax:
Practice Address - Street 1:17140 BERNARDO CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2093
Practice Address - Country:US
Practice Address - Phone:858-451-5190
Practice Address - Fax:588-451-5199
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53905106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist